=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861534471
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRAND SALINE I S D
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 STADIUM DR
-----------------------------------------------------
City | GRAND SALINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75140-1149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-962-7546
-----------------------------------------------------
Fax | 903-962-7464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 STADIUM DR
-----------------------------------------------------
City | GRAND SALINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75140-1149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-962-7546
-----------------------------------------------------
Fax | 903-962-7464
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | KELLY ALLEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 903-962-7546
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------